Bibliographic details of the publications numerically referred to in this specification are collected at the end of the description.
Specific mutations in an amino acid sequence are represented herein as “Xaa1nXaa2” where Xaa1 is the original amino acid residue before mutation, n is the residue number and Xaa2 is the mutant amino acid. The abbreviation “Xaa” may be the three letter or single letter (i.e. “X”) code. The amino acid residues for Hepatitis B virus DNA polymerase are numbered with the residue methionine in the motif Tyr Met Asp Asp (YMDD) being residue number 550.
Hepatitis B virus (HBV) can cause debilitating disease conditions and can lead to acute liver failure. HBV is a DNA virus which replicates via an RNA intermediate and utilizes reverse transcription in its replication strategy (1). The HBV genome is of a complex nature having a partially double stranded DNA structure with overlapping open reading frames encoding surface, core, polymerase and X genes. The complex nature of the HBV genome is represented in FIG. 1.
The presence of an HBV DNA polymerase has led to the proposition that nucleoside analogues could act as effective anti-viral agents. Examples of nucleoside analogues currently being tested are penciclovir and its oral form famciclovir [FAM] (2,3,4,5) and lamivudine [LAM] (6,7). Adefovir has also been shown to have effective anti-HBV activity in vitro.
Hepatitis, due to hepatitis B virus (HBV) reactivation, is a major cause of morbidity and mortality in hepatitis B surface antigen positive (HBsAg+) patients undergoing bone marrow transplantation (BMT) (8-10). The underlying pathogenesis is related to the intense immunosuppression, during cytotoxic or immunosuppressive therapy, which enhances viral replication with a consequent increase in hepatocyte infection. Subsequent reconstitution with donors stem cells, together with the tapering down of the anti-graft-versus-host immunosuppressive agents, restore the immune function. This results in rapid destruction of infected hepatocytes (11). The outcome of allogeneic BMT is also affected by the HBV status of the donor (11). In fact, it has been shown that serological clearance of HBsAg in HBsAg+ recipients after allogeneic BMT was associated with engraftment of hepatitis B surface antibody (anti-HBs) and hepatitis B core antibody (anti-HBc) positive marrow (12-17).
As stated above, FAM is the oral prodrug of penciclovir [9-(4-hydroxy-3-hydroxymethylbut-1-yl) guanine; BRL 39123], which was shown to inhibit hepadnavirus replication in both in vitro and in vivo studies (18-22). Recently, FAM and LAM ((−)-β-2′-deoxy-3′-thiacytidine or 3TC) have been used successfully to prevent/treat hepatitis related to HBV reactivation on withdrawal of chemotherapy/immunosuppression (23, 24) and to prevent HBV recurrence following orthotopic liver transplantation [OLT] (25-28).
Like LAM, FAM resistance in the post-OLT setting has been identified in both immunosuppressed and immunocompetent subjects. The reported FAM polymerase mutations associated with “breakthrough” include G518E (29), V519L (30), G520C (29), P523L (30), L526M (30), L526V (31), T530S (29), V553I (32). Since the polymerase gene of HBV overlaps the envelope gene, mutations in the catalytic domain of the polymerase can affect the amino acid sequence of the envelope protein and vice versa. In particular, the genetic sequence for the neutralization domain of HBV known as the “a” determinant, which is found within the HBsAg and located between amino acids 99 and 169, actually overlaps the major catalytic regions of the viral polymerase protein and in particular domains A and B (33). In fact, V519L, V553I, G518E are associated with changes to the HBsAg of E164D, stop codon at 199 and E164K, respectively (30,32,33). Conversely, use of HBIG for prophylaxis against HBV recurrence after OLT was associated with variants in the HBsAg, which could have concomitant changes in the polymerase gene (34-36). In work leading up to the present invention, the inventors identified the selection of HBV variants in HBsAg positive recipients treated with FAM and/or LAM following allogeneic bone marrow transplantation and post-OLT. In addition to the unique mutations in the HBV polymerase and HBsAg selected during treatment, there were a number of amino acid changes in some HBV isolates which were consistent with a change of HBV genotype in the predominant virus population.
In accordance with the present invention, the inventors have identified variants of HBV, selected following FAM and/or LAM treatment, with mutations in the HBV DNA polymerase gene which reduce the sensitivity of HBV to this nucleoside analogue. Corresponding mutations in the surface antigen also occur. The identification of these HBV variants is important for the development of assays to monitor FAM and/or LAM resistance and/or resistance to other nucleoside analogue therapeutic regimes and to screen for agents which are useful as alternative therapeutic agents.